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Vestibular Tests: Bow and Lean Maneuver


  • One assessment to determine which canal the otoconia are in, if your patient has horizontal canal BPPV is to do the Bow and Lean maneuver.  For the Bow and Lean maneuver you’re going to first ask your patient to bow.  So the patient is going to bow forward with their nose facing the floor.  In this instance, if the debris is in the horizontal canal, it should fall forward towards the cupula and you should see the nystagmus beat towards the affected side.  After the nystagmus has gone away, you’ll ask the patient to lean back with their nose facing the ceiling.  If the debris is in the horizontal canal and its canalithiasis the debris should fall away from the cupula and the nystagmus should be away from the affected side. 

Balance Ear, Nose and Throat;Hearing and Balance